Nokea
A nurse is teaching a client about newly prescribed hydrochlorothiazide (HCTZ). Which of the following statements, if made by the client, indicates an effective understanding of the potential side effects?
- A. I should be cautious about prolonged sun exposure as HCTZ can increase photosensitivity.
- B. I may experience drowsiness and sedation due to the central nervous system depressant effect of HCTZ.
- C. HCTZ can cause hypocalcemia, so I need to increase my intake of foods high in calcium.
- D. I might develop taste disturbances or loss of appetite as a common side effect of HCTZ.
Correct Answer: A
Rationale: HCTZ can cause photosensitivity, increasing the risk of sunburn, so caution with sun exposure indicates correct understanding. HCTZ does not typically cause drowsiness, hypocalcemia, or taste disturbances.
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The nurse has taught a client who has been prescribed clonidine via a transdermal patch. Which of the following statements by the client would indicate a need for further teaching?
- A. I can wear this patch while I shower.
- B. I should keep this patch on for five days.
- C. This medication may make me drowsy.
- D. If I ever have to have a magnetic resonance imaging (MRI), I will need to remove the patch before the test.
Correct Answer: B
Rationale: Clonidine transdermal patches are typically changed every 7 days, not 5 days, so the statement about keeping the patch on for five days indicates a need for further teaching. The other statements are correct: clonidine patches are water-resistant, can cause drowsiness, and must be removed before an MRI due to potential metal content.
The nurse is caring for a three-year-old who is receiving digoxin for congestive heart failure. Which of the following manifestations is an early sign of digoxin toxicity?
- A. dizziness
- B. tachycardia
- C. vomiting
- D. failure to thrive
Correct Answer: C
Rationale: Vomiting is an early sign of digoxin toxicity in children. Dizziness is less common in young children, tachycardia is not typical, and failure to thrive is a chronic issue, not an early sign.
The nurse is reviewing prescriptions for assigned clients. Which prescriptions require follow-up with the primary healthcare provider? A client with
- A. congestive heart failure prescribed diltiazem.
- B. hypertension prescribed clonidine.
- C. diabetes insipidus prescribed hydrocortisone.
- D. pulmonary emboli prescribed clopidogrel.
- E. atrial fibrillation prescribed amiodarone.
- F. bacterial cystitis prescribed valacyclovir.
Correct Answer: C,F
Rationale: Hydrocortisone is not used for diabetes insipidus (desmopressin is typical), and valacyclovir (an antiviral) is incorrect for bacterial cystitis (requires antibiotics). Diltiazem, clonidine, clopidogrel, and amiodarone are appropriate for their respective conditions.
The nurse is assessing a client with systolic heart failure receiving prescribed carvedilol. Which of the following findings would indicate a therapeutic response?
- A. Increased urinary output
- B. Increased left-ventricular ejection fraction (EF)
- C. Increased left-ventricular remodeling
- D. Increased brain natriuretic peptide (BNP)
Correct Answer: B
Rationale: Carvedilol, a beta-blocker, improves left-ventricular ejection fraction in systolic heart failure, indicating a therapeutic response. Increased urinary output, remodeling, or BNP are not desired outcomes.
The clinic nurse is caring for a 38-year-old male
Item 3 of 6
Diagnostic Results
Basic Metabolic Panel (fasting)
• Serum calcium 9.6 mg/dL (2.39 mmol/l) [9.0-10.5 mg/dL (2.24 - 2.61 mmol/l)
• Serum chloride 94 mEq/l (94 mmol/l) 90 to 110 mEq/L (90 -110 mmol/l)
• Serum glucose 126 mg/dL (6.99 mmol/l) 70-110 mg/dL (3.88 - 6.10 mmol/l)
• Serum potassium 4.2 mEq/l (4.2 mmol/l) 3.5 to 5.0 mEq/l (3.5 to 5.0 mmol/l)
• Serum sodium 136 mEq/l (136 mmol/l) 135 to 145 mEq/l (135 to 145 mmol/l)
• Serum creatinine 0.9 mg/dl (79.5 mcmol/l) 0.6 to 1.1 mg/dl (53 to 106 mcmol/l)
• Blood urea nitrogen 19 mg/dl (6.78 mmol/l) 10 to 20 mg/dl (3.57 to 7.14 mmol/l)
Lipid Panel (fasting)
• Total cholesterol 235 mg/dl (6.07 mmol/l) [less than 200 mg/dl (<5.18 mmol/l)]
• High-density lipoprotein (HDL) 35 mg/dl (0.91 mmol/l) [more than 45 mg/dL (>0.75 mmol/L) for men; more than 55 mg/dL (>0.91 mmol/L) for women]
• Low-density lipoprotein (LDL) 135 mg/dl (3.49 mmol/l) [less than 130 mg/dL (< 3.36 mmo/l)]
• Triglycerides 299 mg/dL [Females: 35-135 mg/dL or 0.40-1.52 mmol/L; Males: 40-160 mg/dL or 0.45-1.81 mmol/L]
Thyroid Panel
• Triiodothyronine (T3) 87 ng/dL (1.3 nmol/L) [80-200 ng/dL (1.2-3 nmol/L)]
• Thyroxine (T4) 5.4 µg/dL (69 nmol/L) [5.4-11.5 (69-148 nmol/L)]
• Thyroid-stimulating hormone (TSH) 4.0 µIU/mL (4.0 mIU/L) [0.45-4.5 µIU/mL (0.45-4.5 mIU/L)]
Follow-up Nurses' Notes
1345 - Client presents for a one-week follow-up appointment to review his laboratory results. The client reports no acute complaints, denies pain, and states he has been checking his blood pressure while at the grocery store "with the top number being in the 150s". Oral temperature 98.6°F (37° C) Pulse 88 Respiratory Rate 16 Blood Pressure 143/91 mm Hg Pulse oximetry 95% on room air. Current weight 270 pounds (122.72 kilograms); Body Mass Index 29. 41 inches (102 cm) waist size.
The nurse completes and reviews the follow-up nurses' notes and the laboratory results.Complete the following sentence below from the list of options. Based on the clinical data, this client is at the highest risk of developing.............
- A. hypothyroidism
- B. metabolic syndrome
- C. renal insufficiency
- D. secondary hypertension
Correct Answer: B
Rationale: The client has elevated blood pressure (143/91 mm Hg), high fasting glucose (126 mg/dL), hyperlipidemia (high cholesterol, LDL, triglycerides, low HDL), and obesity (BMI 29, waist 41 inches), which are diagnostic criteria for metabolic syndrome.